PRINTED BY THE DEPT. OF MEDICAL PHOTOGRAPHY AND ILLUSTRATION A.M.N.C.H.

In-process checking: Expanding the role of the senior pharmaceutical technician in the Aseptic Unit.

O’Meara J, Cullen N, Byrne L.

Pharmacy Department, AMNCH, Tallaght, Dublin.

BACKGROUND AND OBJECTIVESA green belt project1 undertaken by the Aseptic Unit (AU) manager identified that only 22% of oncology day ward patients receive their chemotherapy drugs within an acceptable period of time. At any one time in the unit there are up to 4 technicians but only ever one pharmacist. Pharmacists were interrupted from the task in hand for 50% of their rostered time. Figure 1 identified one of the reasons for this is that skill mix is not being utilised effectively as the pharmacist is responsible for the start and end points of process.

Figure 1 Process Map from Confirmation to Supply

Based on these results it was decided that roles such as processing prescriptions and in-process checking would be redistributed to senior technicians.

In-process checking had always been previously carried out by a pharmacist. In-process checking includes checking the technicians diluent and infusion volumes prior to addition to the final container. During this check the diluent, drug vial, infusion fluid, equipment and label are checked for appropriateness. This check can involve a total of 15 individual checks at two separate steps (diluent checks and final volume checks). The worksheet is then signed on completion of each step.

This is a new role for technicians in AMNCH and involves procedural changes and training. The South West Accuracy Assessment course for pre and in-process checking was attended in the UK2. The objective of undergoing this course was to reduce the workload of the pharmacist by allowing a senior technician to carry out in-process checks, to increase skill mix , and decrease the waiting time for checks.

METHODOLOGY

The South West In-Process Checking Course Content2

The course took place over 2 days.The main topics covered in the course were:

• the aim of the accuracy assessment• who can complete the assessment• what is a check?• how to complete the assessment• errors• legal issues

A workbook was distributed with information on data collection which was to be collected back on site.

RESULTS

The South West Accuracy Assessment course2 was completed, accreditation was received and in-process checking commenced within the AU.

These changes were accepted by all AU staff members.

SOPs and the senior technician job description were updated to include that senior technicians were now doing in-process checking on completion of the in-process checking course. A re-audit of the green belt project1 was carried out by the Aseptic Unit manager which showed that 71% of oncology day ward patients now receive their chemotherapy drugs within a 60 minute time frame from confirmation. In-process checking by technicians has contributed to this improvement.

Having the senior technician undertaking extra duties previously done by a pharmacist such as in-process checking and processing prescriptions has improved skill mix.

Figure 3 New Process Map from Confirmation to Supply

Pharmacist interruptions have reduced to 26% in a 2 hour roster1.

CONCLUSION

In-process checking by technicians reduces the workload for pharmacists and created a shorter waiting time for volume checks for technicians. This is turn has improved the turnaround time for processing of prescriptions from start to finish and receipt of chemotherapy on the ward.

REFERENCES

1 Byrne L, Mc Donnell F, Harte D, O Brady C, Macken S, Strickland M, Improving the Supply of Chemotherapy Drugs to the Oncology Day Ward using Six Sigma Process Improvement Methodology

2 South West Medicines Information and Training, South West Accuracy Assessment for pre and in-process checking in non-licensed units (Section 10)

METHODOLOGY cntd

Informing All stakeholdersThe AU manager informed the other pharmacists about the course, the training involved, and the change in the senior technician role before any training began. The other technicians in the unit were also informed of what was happening. A short presentation was also made to the entire pharmacy dept outlining the course and the steps involved in bringing about this change.

Legal AspectsThe legal aspects of having a technician carrying out the in-process checks were discussed with the Pharmacy Operations Manager and the Head of Pharmacy. The hospital indemnity scheme was checked to ensure that technicians were legally covered to carry out in process checks.

TrainingAs technicians already do the pre-process checking e.g. tray checks and processing it was decided that senior technicians would be validated only in the in-process checking i.e. carrying out volume checks.

Figure 2 Technician carrying out in-process checks

Training RequiredIn house training took place over 4 weeks.

Week 1• Re read SOPs.• Observation of checking process.• Checking under supervision.

Weeks 2-4• Carrying out in-process volume checks with a pharmacist double checking all volumes.• Filling in all relevant paper work. • Submission of portfolio to The South West Medicines Information & Training Board2.

Correspondence to jennifer.omeara@amnch.ie

Prioritise on Oncology List

Locate Prescripiton

Write Label

Process W/S & Labels

Check Handwritten Label againist W/S

Place Label & W/S On Set up Bench Set Up tray

Check tray

Place W/S on checking bench Spray tray into Clean Room

Spray Tray into Isolator Compound

Check Volume Add Volume

Complete Clean Up

Place Tray in Hatch

Remove Tray & Place on W/S

Prepare Bag LabelsCheck & Label Product

Seal Product in Bag

Check Product Against RX

Tick Diary Entry

Place W/S under keyboard

Bleep Attendant

Place in Bag for Collection To Ward Attendant

Pharmacist Technician Floater

From Nurse

Compounding Technician

Senior Technician

Prioritise on Oncology List

Locate Prescripiton

Write Label

Process W/S & Labels

Check Handwritten Label againist W/S

Place Label & W/S On Set up Bench

Set Up tray

Check tray

Place W/S on checking bench Spray tray into Clean Room

Spray Tray into Isolator Compound

Check Volume Add Volume

Complete Clean Up

Place Tray in Hatch

Remove Tray & Place on W/S

Prepare Bag LabelsCheck & Label Product

Seal Product in Bag

Check Product Against RX

Tick Diary Entry

Place W/S under keyboard

Bleep Attendant

Place in Bag for Collection To Ward Attendant

Pharmacist Technician Floater

From Nurse

Compounding Technician